CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to U.S. Provisional Patent Application No. 62/394,977, filed September 15, 2016, which is incorporated by reference in its entirety.

INCORPORATION BY REFERENCE OF MATERIAL SUBMITTED ELECTRONICALLY

[0002] Incorporated by reference in its entirety is a computer-readable

nucleotide/amino acid sequence listing submitted concurrently herewith and identified as follows: 48,000 byte ACM (Text) file named "51087A_SeqListing.txt"; created on September 14, 2017.

BACKGROUND

[0003] Islet transplantation is an effective cell therapy for type 1 diabetes (T1 D), but its clinical application is limited by the shortage of donors. Among all alternative sources of islets, the differentiation of human pluripotent stem cells (hPSCs), chiefly human embryonic stem cells (hESc), has taken an early lead. The initiation of nationwide Phase l/ll clinical trials for T1 D using hESc-derived pancreatic progenitors by Viacyte, Inc. (based on ^{1 2} ), as well as the recent publication of key advances in the maturation of functional β-cells in vitro ^3"8 have galvanized the field. However, while the proportion of β-like cells obtained through state-of-the-art terminal differentiation methods is relatively high (30-40%) ^4,5 a significant percentage of undefined non- endocrine cell types are also generated ^4,9 . Most importantly, there is the potential for carry-over of non-differentiated cell types that may produce teratomas upon

transplantation. The formation of complex teratomas consisting of derivatives from the three germ layers was the result of transplantation of hPSC into immunodeficient rodents. In fact, the test for teratoma formation is routinely used to test the pluripotency of hESc (and more recently, iPSc) ¹⁰ . In the context of hPSC-based clinical therapies, the formation of teratomas would obviously be an undesired occurrence. As differentiation is hardly a synchronous process, teratomas tend to arise either from carry-over undifferentiated cells or from cells that de-differentiate upon transplantation ^{11 14} . They are common in protocols in which non-terminally differentiated cells are allowed to mature in vivo ¹ . The formation of teratomas is a major cause of concern for regulatory agencies ¹⁵ .

[0004] Although refinements of the prevailing differentiation protocols have significantly reduced this risk in preclinical studies, the foreseeable implementation of hPSC-based therapies in thousands of patients calls for caution. One single case of hPSC-derived tumors in patients may set the entire field back for years.

[0005] Some research groups have approached the problem of hPSC tumorigenesis by screening the number of undifferentiated cells in each transplantable preparation. If such number is below the threshold known to produce teratomas in immunodeficient mice, they argue, these preparations should be considered safe for clinical use ³⁴ .

However, this method does not take into account the risk of de-differentiation after transplantation ¹¹ . hPSC-based therapies are predicted to reach millions of patients in the near future. It would take only one incidence of tumorigenesis to bring the entire field to a screeching halt, perhaps for years. For this reason, other groups have proposed the use of engineered hPSC with integrated safeguards, namely suicide genes. However, the pro-drug to which the suicide genes confer sensitivity, kill the whole graft, including the cells for which there was a need in the first place.

Considering the frequency at which teratogenic lesions are observed in numerous experimental conditions, such safeguard would render the entire approach impractical.

[0006] Thus, there is a need for means by which modified hESc and induced pluripotent stem cell (iPSc) lines that can be efficiently differentiated and safely transplanted. There is a need for a means by which "good" cells are selectively preserved, while cells with tumorigenic potential are destroyed.

SUMMARY

[0007] The present disclosure provides a recombinant expression vector system that provides an integrated fail-safe mechanism that allows for selective elimination of tumorigenic cells while preserving cells of therapeutic value, thereby providing a means by which modified stem cells can be safely transplanted into subjects in need therefor.

[0008] In exemplary embodiments, the recombinant expression vector system comprises at least two suicide genes, one of which is specifically inactivated in cells exhibiting the desired phenotype. In exemplary embodiments, the recombinant expression vector system comprises at least two suicide genes, one of which is specifically excised, removed or deleted in cells exhibiting the desired phenotype. In exemplary embodiments, the recombinant expression vector system comprises at least two suicide genes, one of which is specifically excised, removed or deleted via action of a recombinase in cells exhibiting the desired phenotype. In exemplary aspects, at least one of the two suicide genes is activated when the cell the recombinant expression vector system behaves similarly to or the same as a tumor cell. In exemplary aspects, the expression of at least one of the two suicide genes is controlled by a promoter which is highly active in a tumor or cancer cell.

[0009] In exemplary aspects, the recombinant expression vector system of the present disclosure comprises at least one suicide gene located between two loxP sites, two HIV markers, or two FRT sites. In exemplary aspects, the recombinant expression vector system comprises a nucleic acid encoding a recombinase, including, e.g., FLT, Cre, Tre. In exemplary aspects, expression of the nucleic acid encoding the Cre recombinase is controlled by a promoter which is tissue-specific or hormone- responsive. In exemplary aspects, the recombinant expression vector system

comprises a telomerase promoter controlling the expression of at least one suicide gene.

[0010] Also provided by the present disclosure is a host cell comprising any one of the recombinant expression vector systems described herein, and kits comprising such host cells or recombinant expression vector systems. In exemplary embodiments, the kit comprises at least one agent which causes cell death to cells expressing a suicide gene. [0011] Further provided is a method of producing stem cells suitable for transplantation into a subject. In exemplary embodiments, the method comprising contacting a cell culture comprising stems cells with any one of the recombinant expression vector systems described herein and adding to the cell culture an agent which causes cell death to cells expressing a suicide gene or an agent which causes cell death or to cells not expressing a selectable marker.

[0012] Furthermore provided is a method of transplanting stem cells to a subject in need thereof, comprising administering to the subject stem cells comprising the recombinant expression vector system of the present disclosure and administering to the subject an agent which causes cell death to cells expressing a suicide gene.

Without being bound to a particular theory, the administration, e.g., transplantation, of such stem cells with the recombinant expression vector of the present disclosure provides cells which differentiate into cells having therapeutic value. Thus, the administration, e.g., transplantation, of such stem cells with the recombinant expression vector of the present disclosure provides therapeutic treatment of the subject.

Accordingly, the present disclosure provides methods of treating a disease in a subject in need thereof, comprising administering, e.g., transplanting, stem cells with the recombinant expression vector of the present disclosure in an amount effective to treat the disease.

BRIEF DESCRIPTION OF THE DRAWINGS

[0013] Figure 1 is an illustration depicting a mechanism of action relating to engineered human pluripotent stem cell (hPSCs), which can be used for β-cell differentiation protocols, which also yield other cell types (non-specific differentiation) and, potentially, proliferative escapees. The construct pictured at the top is designed so that a loxP-flanked suicide gene (nitroreductase, NR) will be selectively excised out in insulin-expressing cells by virtue of the expression of Cre recombinase placed under the control of the insulin promoter. A second suicide gene (thymidine kinase, TK), which is expressed only in telomerase ⁺ cells (TelP promoter), remains silent in β-cells. As a consequence, only insulin ⁺ cells will be resistant to both CB1954 (the pro-drug activated by NR activity) and GCV (the pro-drug activated by TK). All other possible outcomes bring about the expression of one or both suicide genes. Neo = neomycin resistance cassette (SV40 promoter); NR = nitroreductase cassette (CMV promoter); TelP = telomerase promoter; TK = HSV thymidine kinase; hIP = human insulin promoter; Cre = Cre recombinase; S = sensitive; R = resistant.

[0014] Figure 2 is a set of images demonstrating H1 parental hESc cultures are resistant to GCV and CB1954 after 7 days of exposure (left column). In contrast, H1 .1 cells, which contain two suicide constructs that render them sensitive to both pro-drugs, are 100% ablated after 7 days of exposure.

[0015] Figure 3 is a schematic diagram of the pPURHtertpTKHipCre vector comprising a nucleic acid (SEQ ID NO: 2) encoding human insulin promoter (HlP)-Cre recombinase with a Myc tag, a nucleic acid encoding HSV thymidine kinase (HSVTK) under the control of a telomerase promoter (hTERTp), and a nucleic acid encoding a selectable marker which provides resistance to ampicillin (AmpR).

[0016] Figure 4 is a schematic diagram of the pUC57LoxNRNeoRLox vector comprising a nucleic acid (SEQ ID NO: 1 ) encoding NRNeo flanked by two Lox sites and a nucleic acid encoding a selectable marker which provides resistance to neomycin and kanamycin (NeoR/KanR).

[0017] Figure 5 is a schematic diagram of an exemplary recombinant expression vector comprising all components of the recombinant expression vector system of the present disclosure. RIP = rat insulin promoter, which is expressed in insulin-producing cells, such as islet beta cells; Cre = Cre recombinase, which excises any length of DNA comprised between two loxP sites; CMV = cytomegalovirus promoter, which ensures high constitutive levels of gene expression in mammalian cells; TK = thymidine kinase, which destroys the cell in the presence of the pro-drug ganciclovir; Telom = human telomerase promoter, which is expressed in non-terminally differentiated cells, as well as in active tumors; Gpt = guanine phosphoribosyl transferase, which destroys the cell in the presence of the pro-drug 6-TX; Selectable marker is used to select for stably transfected cell clones.

[0018] Figure 6 is a set of illustrations that depict the general strategy to genetically modify pluripotent stem cells with suicide gene constructs designed to selectively preserve the cells of the desired phenotype and kill cells with tumorigenic potential. Figure 6A depicts two vector constructs. Construct A comprises a CMV promoter and a nitroreductase gene (coNTR) followed by a neomycin resistance gene cassette. Such components are flanked by LoxP sites. Construct B comprises a telomerase promoter followed by a HSV-TK gene cassette. Construct B also comprises a human insulin promoter (hIP) followed by Cre recombinase gene cassette. Construct B further comprises an SV40 promoter followed by a puromycin resistance gene cassette. Figure 6B depicts the mechanism of action of the constructs in cells under different conditions. hIP is active in insulin-positive cells causing the expression of Cre recombinase which acts on Construct A to cause excision of the components flanked between the LoxP sites, so that only LoxP remains in the construct.

[0019] Figure 7A is a set of graphs demonstrating that AH1 cells (also referred to herein as "H1 .1 cells"), but not H1 cells, express both the nitroreducatse (NTR) and Herpes Simplex Virus Thymidine Kinase (HSV-TK) transgenes. Figure 7B is a pair of photographs showing the morphology of AH1 colonies. Figure 7C is a set of flow cytometry scatter plots and graphs depicting the pattern of expression of pluripotency markers. Figure 7D is a graph depicting the fold expression (vs. NUFF cells) of Oct3/4 or Nanog in H1 cells or H1 cells, as determined qRT-PCR. Figure 7E is a set of

immunofluorescent images depicting that the expression of indicated markers by AH1 cells were largely indistinguishable from those observed in the parental (unmodified) H1 cell line.

[0020] Figure 8A is a set of images of ΛΗ1 cells or H1 cells treated with CB1954 (left column) or GCV (right column). Figure 8B is a set of graphs depicting the viability curve of both H1 and H1 cells when exposed to the CB1954 or GCV dosages for 7 days. % viability is shown 24 hours and 72 hours post treatment. Figure 8C is a pair of graphs demonstrating the percentage of viable cells expressed as a function of time after treatment with CB1954 (left graph) or with GCV (right graph).

[0021] Figure 9A is a series of photographs demonstrating an outline of the stages of the protocol (DE: definitive endoderm; PF: posterior foregut; PE: pancreatic endoderm; LC: β-like cells). Figure 9B is a series of graphs depicting gene expression patterns, as determined by qRT-PCR of a panel of representative genes at each stage. Figure 9C is a series of representative immunofluorescent images at the different stages of differentiation (from PF onwards). The percentage of the pancreatic progenitor markers PDX1 ⁺ and NKX6.1 ⁺ at the end of stage 4 (PE), which is used as a quality control for preparations prior to the last differentiation step, was similar for both the modified and the parental cell line (46.4 vs. 47.6 %, respectively), and in line with previously reported results. The bottom-right picture shows a magnified detail of the insulin staining at the last stage.

[0022] Figure 10A is a series of graphs demonstrating the % viable cells under the indicated conditions: The top, left graph shows that the percentage of live AH1 cells that co-express PDX1 and NKX6.1 differs significantly between the untreated (38.3 ± 6.3 %, black column, left) and the treated (85.2 ± 4.7 %, black column, right) (P=0.0001 ). The top, right graph shows 29.6 ± 7.5 % of untreated vs. 81 .7 ± 6.4 % of treated cells

(P=0.004). The bottom graphs demonstrate that the parental H1 line does not show any statistically significant differences between treated and untreated groups. Figure 10B is a series of graphs depicting the fold expression of the indicated pancreatic endocrine gene as measured by qRT-PCR at the conclusion of the experiment, for both treated and untreated AH1 and H1 cells. Figure 10C is a comparison of specific pancreatic markers between islets and -/7-derived and selected β-like cells. Figure 10D is a depiction that confirms the overall similitude of their transcriptional profile.

[0023] Figure 11 A is a graph of the teratoma volume (mm ³ ) of mice transplanted with H1 undifferentiated hES cells and treated with a combination of GCV and CB1954.

Figure 11 B is a graph of the teratoma volume (mm ³ ) of mice transplanted with H1 undifferentiated hES cells and re-treated with GCV. DETAILED DESCRIPTION

[0024] The present disclosure provides a recombinant expression vector system providing an integrated fail-safe mechanism that will allow for selective elimination of tumorigenic cells while preserving cells of therapeutic value, thereby allowing a means by which modified stem cells can be safely transplanted into subjects in need therefor.

[0025] As used herein, the term "recombinant expression vector system" refers to one recombinant expression vector comprising all components or a set of two or more recombinant expression vectors designed to function together. For purposes herein, the term "recombinant expression vector" means a genetically-modified oligonucleotide or polynucleotide construct that permits the expression of an imRNA, protein,

polypeptide, or peptide by a host cell, when the construct comprises a nucleotide sequence encoding the imRNA, protein, polypeptide, or peptide, and the vector is contacted with the cell under conditions sufficient to have the imRNA, protein, polypeptide, or peptide expressed within the cell. The vectors of the disclosure are not naturally-occurring as a whole. However, parts of the vectors can be naturally- occurring. The inventive recombinant expression vectors in exemplary aspects comprise any type of nucleotides, including, but not limited to DNA and RNA, which may be single- stranded or double-stranded, synthesized or obtained in part from natural sources, and which in exemplary aspects contain natural, non-natural or altered nucleotides. The recombinant expression vectors in exemplary aspects comprise naturally-occurring or non-naturally-occurring internucleotide linkages, or both types of linkages. In exemplary aspects, the altered nucleotides or non-naturally occurring internucleotide linkages do not hinder the transcription or replication of the vector.

[0026] The recombinant expression vector system of the present disclosure may comprise any suitable recombinant expression vector, and may be used to transform or transfect any suitable host. Suitable vectors include those designed for propagation and expansion or for expression or both, such as plasmids and viruses. The vector can be selected from the group consisting of the pUC series (Fermentas Life Sciences), the pBluescript series (Stratagene, LaJolla, CA), the pET series (Novagen, Madison, Wl), the pGEX series (Pharmacia Biotech, Uppsala, Sweden), and the pEX series (Clontech, Palo Alto, CA). In exemplary aspects, the recombinant expression vector system of the present disclosure comprises one or more vectors comprising all or part of pUC57 (GenScript; Piscataway, NJ) or all or part of pPUR (Clontech; Mountainview; CA).

Bacteriophage vectors, such as AGTIO, AGTI 1 , AZapll (Stratagene), AEMBL4, and ANMI 149, also can be used. Examples of plant expression vectors include pBIOI, pBI101 .2, pBI101 .3, pBI121 and pBIN19 (Clontech). Examples of animal expression vectors include pEUK-CI, pMAM and pMAMneo (Clontech). In exemplary aspects, the

recombinant expression vector is a viral vector, e.g., a retroviral vector, an adenovirus vector, an adeno-associated virus (AAV) vector, or a lentivirus vector.

[0027] The recombinant expression vectors and systems comprising the same of the present disclosure can be prepared using standard recombinant DNA techniques described in, for example, Maniatis and Sambrook, Molecular Cloning: A laboratory manual, 4 ^th ed., Cold Spring Harbor, NY, Cold Spring Harbor Laboratory (2014) and Ausubel, Current Protocols in Molecular Biology John Wiley & Sons, Hoboken, NJ, (1995). Constructs of expression vectors, which are circular or linear, can be prepared to contain a replication system functional in a prokaryotic or eukaryotic host cell.

Replication systems can be derived, e.g., from ColEI, 2 μ plasmid, A, SV40, bovine papilloma virus, and the like. In exemplary aspects, the recombinant expression vector system comprises an ori sequence which signals for the origin of replication. In exemplary aspects, the ori comprises a sequence of SEQ ID NO: 10, 19, or 27, or a combination thereof.

[0028] In exemplary aspects, the recombinant expression vector system comprises regulatory sequences, such as transcription and translation initiation and termination codons, which are specific to the type of host (e.g., bacterium, fungus, plant, or animal) into which the vector is to be introduced, as appropriate and taking into consideration whether the vector is DNA- or RNA- based. In exemplary aspects, the recombinant expression vector system comprises a polyadenylation signal (poly(A) signal). In exemplary aspects, the recombinant expression vector system comprises several poly(A) signals. In exemplary aspects, the poly(A) signal is a bovine growth hormone poly(A) signal, optionally, comprising the sequence of SEQ ID NO 9. In exemplary aspects, the poly(A) signal is an SV40 poly(A) signal, optionally, comprising the sequence of SEQ ID NO 13 or SEQ ID NO: 24. In exemplary aspects, the poly(A) signal is an beta-globin poly(A) signal, optionally, comprising the sequence of SEQ ID NO 34. In exemplary aspects, the recombinant expression vector system comprises a bi-allelic poly(A) trap vector, optionally, comprising the sequence of SEQ ID NO 30. In exemplary aspects, the recombinant expression vector system comprises a trans-acting transcriptional activator binding site. In exemplary instances, the transcriptional activator is a catabolite activator protein (CAP). In exemplary aspects, the CAP binding site comprises the sequence of SEQ ID NO: 18. In exemplary aspects, the recombinant expression vector system comprises an operator. In exemplary instances, the operator is a Lac operator, and optionally comprises the sequence of SEQ ID NO: 16.

Alternative and additional sequences may be a part of the recombinant expression vector system.

[0029] In exemplary aspects, the recombinant expression vector system comprises one or more enhancer sequences, which enhance or increase the likelihood of transcription of a gene. See, e.g., Pennacchio et al., Nat Rev Genet 14(4): 288-295 (2013). In exemplary aspects, the enhancer is a human enhancer or a viral enhancer. The viral enhancer may be an SV40 enhancer or cytomegalovirus (CMV) enhancer. In exemplary aspects, the CMV enhancer comprises the sequence of SEQ ID NO: 5.

[0030] The recombinant expression vector system may include one or more marker genes, e.g., selectable marker genes, which allow for selection of transformed or transfected hosts. Selectable marker genes include biocide resistance, e.g., resistance to antibiotics, heavy metals, etc., complementation in an auxotrophic host to provide prototrophy, and the like. Suitable selectable marker genes for the expression vectors include, for instance, kanamycin resistance genes, puromycin resistance genes, zeocin resistance genes, neomycin/G418 resistance genes, hygromycin resistance genes, histidinol resistance genes, tetracycline resistance genes, geneticin resistance genes, triclosan resistance genes, R-fluroorotic acid resistance genes, 5-fluorouracil resistance genes and ampicillin resistance genes. In exemplary aspects, the recombinant expression vector system comprises one or more of a neomycin resistance gene, an ampicillin resistance gene, and a puromycin resistance gene. In exemplary aspects, the recombinant expression vector system comprises a neomycin resistance gene, two ampicillin resistance genes, and a puromycin resistance gene. In exemplary instances, the recombinant expression vector system comprises a neomycin resistance gene comprising the sequence of SEQ ID NO: 12, two ampicillin resistance genes (one comprising the sequence of SEQ ID NO: 20 and another comprising the sequence of SEQ ID NO: 26), and a puromycin resistance gene comprising the sequence of SEQ ID NO: 23.

[0031] In exemplary aspects, the recombinant expression vector system comprises one or more protein tags. Such tags can facilitate purification of the expressed protein or detect expression of the protein. In exemplary aspects, protein tag is a histidine tag, a Myc tag, a glutathione S-transferase (GST) tag. In exemplary aspects, the Myc tag is encoded by a sequence comprising SEQ ID NO: 33.

[0032] In exemplary aspects, the recombinant expression vector system comprises one or more sequencing primers for verification of sequence of the recombinant expression vector system. Sequencing primers are known in the art and include but not limited to CMV sequencing primers, MSCV sequencing primers, pGEX or pBABE sequencing primers, SP6, T3, T7, LK01 .5', and M13 sequencing primers. In exemplary aspects, the sequencing primer is a M13 forward primer sequence, optionally, comprising the sequence of SEQ ID NO: 3. In exemplary aspects, the sequencing primer is a M13 reverse primer sequence, optionally, comprising the sequence of SEQ ID NO: 15.

[0033] The recombinant expression vector system in exemplary aspects comprises a native or normative promoter operably linked to the nucleotide sequence encoding the polypeptide (including functional portions and functional variants thereof), or to the nucleotide sequence which is complementary to or which hybridizes to the nucleotide sequence encoding the polypeptide. The selection of promoters, e.g., strong, weak, inducible, tissue-specific and developmental- specific, is within the ordinary skill of the artisan. Similarly, the combining of a nucleotide sequence with a promoter is also within the skill of the artisan. The promoter can be a non-viral promoter or a viral promoter, e.g., a cytomegalovirus (CMV) promoter, an SV40 promoter, an RSV promoter, or a promoter found in the long-terminal repeat of the murine stem cell virus. In exemplary instances, the recombinant expression vector system comprises a CMV promoter and an SV40 promoter. In exemplary instances, the CMV promoter comprises the

sequence of SEQ ID NO: 5. In exemplary instances, the SV40 promoter comprises the sequence of SEQ ID NO: 1 1 or SEQ ID NO: 22. In exemplary instances, the

recombinant expression vector system comprises a CMV promoter comprising the sequence of SEQ ID NO: 5, a first SV40 promoter comprising the sequence of SEQ ID NO: 1 1 and a second SV40 promoter comprising the sequence of SEQ ID NO: 22. In exemplary aspects, the recombinant expression vector system comprises additional promoters, e.g., T7 promoter, Lac promoter, or Amp promoter. In exemplary aspects, the T7 promoter comprises the sequence of SEQ ID NO: 7. In exemplary aspects, the Lac promoter comprises the sequence of SEQ ID NO: 17. In exemplary aspects, the Amp promoter comprises the sequence of SEQ ID NO: 21 or SEQ ID NO: 25.

[0034] The recombinant expression vector system may be designed for either transient expression, for stable expression, or for both. In exemplary aspects, the recombinant expression vector system comprises elements necessary for integration into the host genome. Also, the recombinant expression vectors can be made for constitutive expression or for inducible expression. For example, the recombinant expression vector system may comprise one or more suicide genes and/or one or more constitutive or inducible promoters.

[0035] In exemplary aspects, the recombinant expression vector system comprises one or more modified nucleotides and/or one or more modified inter-nucleotide linkages. In exemplary aspects, the recombinant expression vector system comprises one or more modified nucleotides selected from the group consisting of: 5-fluorouracil, 5- bromouracil, 5-chlorouracil, 5-iodouracil, hypoxanthine, xanthine, 4-acetylcytosine, 5- (carboxyhydroxymethyl) uracil, 5- carboxymethylaminomethyl-2-thiouridine, 5- carboxymethylaminomethyluracil, dihydrouracil, beta-D- galactosyl queuosine, inosine, N6-isopentenyladenine, 1 -methylguanine, 1 -methylinosine, 2,2-dimethylguanine, 2- methyladenine, 2-methylguanine, 3-methylcytosine, 5-methylcytosine, N -substituted adenine, 7-methylguanine, 5-methylammomethyluracil, 5- methoxyaminomethyl-2- thiouracil, beta-D-mannosyl queuosine, 5'- methoxycarboxymethyluracil, 5- methoxyuracil, 2-methylthio-N6-isopentenyladenine, uracil-5-oxyacetic acid (v), wybutoxosine, pseudouracil, queuosine, 2-thiocytosine, 5-methyl-2-thiouracil, 2- thiouracil, 4-thiouracil, 5-methyluracil, uracil-5-oxyacetic acid methylester, 3- (3-amino- 3-N-2-carboxypropyl) uracil, and 2,6-diaminopurine. In exemplary aspects, the recombinant expression vector system comprises one or more modified inter-nucleotide linkages selected from the group consisting of: phosphoroamidate linkages and phosphorothioate linkages.

[0036] In exemplary embodiments, the recombinant expression vector system comprises at least two suicide genes, one of which is specifically inactivated in cells exhibiting the desired phenotype. In exemplary embodiments, the recombinant expression vector system comprises at least two suicide genes, one of which is specifically excised, removed or deleted in cells exhibiting the desired phenotype. In exemplary embodiments, the recombinant expression vector system comprises at least two suicide genes, one of which is specifically excised, removed or deleted via action of a recombinase in cells exhibiting the desired phenotype. In exemplary aspects, at least one of the two suicide genes is activated when the cell the recombinant expression vector system behaves similarly to or the same as a tumor cell. In exemplary aspects, the expression of at least one of the two suicide genes is controlled by a promoter which is highly active in a tumor or cancer cell.

[0037] In exemplary aspects, the recombinant expression vector system of the present disclosure comprises at least one suicide gene located between two loxP sites, two HIV markers, or two FRT sites. In exemplary aspects, each loxP site comprises a sequence of SEQ ID NO: 4 or SEQ ID NO: 14. In exemplary aspects, the recombinant expression vector system comprises a nucleic acid encoding a recombinase, including, e.g., FLT, Cre, Tre. In exemplary aspects, the Cre recombinase is encoded by a sequence of SEQ ID NO: 32. In exemplary aspects, expression of the nucleic acid encoding the Cre recombinase is controlled by a promoter which is tissue-specific or hormone-responsive. In exemplary aspects, the recombinant expression vector system comprises a telomerase promoter controlling the expression of at least one suicide gene. In exemplary aspects, the telomerase promoter is a human telomerase reverse transcriptase (hTERT) promoter. In exemplary instances, the hTERT promoter comprises the sequence of SEQ ID NO: 28.

[0038] In exemplary embodiments, the recombinant expression vector system comprises at least two suicide genes, one of which is specifically inactivated in cells exhibiting the desired phenotype. In exemplary aspects, at least one of the two suicide genes is activated when the cell expressing the recombinant expression vector system behaves similarly to or the same as a tumor cell. In exemplary aspects, the

recombinant expression vector system of the present disclosures comprises at least one suicide gene located between two loxP sites. In exemplary aspects, the

recombinant expression vector system comprises a nucleic acid encoding Cre recombinase. In exemplary aspects, expression of the nucleic acid encoding the Cre recombinase is controlled by a promoter which is tissue-specific or hormone- responsive. In exemplary aspects, the recombinant expression vector system comprises a telomerase promoter controlling the expression of at least one suicide gene. In exemplary aspects, the telomerase promoter is a human telomerase reverse transcriptase (hTERT) promoter. In exemplary aspects, each loxP site comprises a sequence of SEQ ID NO: 4 or SEQ ID NO: 14. In exemplary aspects, the Cre recombinase is encoded by a sequence of SEQ ID NO: 32. In exemplary instances, the hTERT promoter comprises the sequence of SEQ ID NO: 28.

[0039] In exemplary aspects, the recombinant expression vector system comprises only one recombinant expression vector comprising the at least two suicide genes. Alternatively, the recombinant expression vector system comprises more than one recombinant expression vector. In exemplary aspects, the recombinant expression vector system comprises one recombinant expression vector per number of suicide genes in the system. In exemplary aspects, the recombinant expression vector system comprises two suicide genes and two recombinant expression vectors. In exemplary aspects, the recombinant expression vector system comprises two, three, four, five, or more recombinant expression vectors.

[0040] In exemplary aspects, the recombinant expression vector system comprises a first suicide gene and expression of the first suicide gene is controlled by a constitutive promoter, including but not limited to SV40, UBC, EF1 A, PGK and CAGG (Qin et al, PLOS One 5(5): e1061 1 ). In exemplary aspects, the expression of the first suicide gene is controlled by a cytomegalovirus (CMV) promoter. In exemplary aspects, the first suicide gene is subject to removal, excision or deletion by means of a Cre-lox system. In exemplary aspects, the first suicide gene is located in a recombinant expression vector between two lox sites. In exemplary aspects, the recombinant expression vector system comprises a nucleic acid encoding Cre recombinase. In exemplary aspects, the promoter which controls expression of Cre is activated when the cell expressing the recombinant expression vector system has differentiated into the intended cell type. In exemplary aspects, expression of Cre is controlled by a tissue- specific promoter or hormone-responsive promoter. In exemplary aspects, the tissue- specific promoter is an islet beta cell-specific promoter. In exemplary aspects, the hormone-responsive promoter is an insulin-responsive promoter. In exemplary aspects, the insulin-responsive promoter is a rat insulin promoter or a human insulin promoter (hIP). In exemplary aspects, the hIP comprises the sequence of SEQ ID NO: 31 . In exemplary aspects, the tissue specific promoter is pancreatic pan-endocrine (IS1 , CGA, SYP, etc.). In exemplary aspects, the tissue-specific promoter is a liver-specific promoter, or an albumin promoter. In exemplary aspects, the promoter controlling the expression of Cre and the nucleic acid encoding Cre are located in the same

recombinant expression vector as the first suicide gene and the lox sites. Alternatively, the promoter controlling the expression of Cre and the nucleic acid encoding Cre are located in a recombinant expression vector which is different from the one comprising the first suicide gene and the loxP sites. In exemplary aspects, the Cre-lox system of the recombinant expression vector system is replaced with another recombinase system. In exemplary aspects, FLT recombinase and FRT sites are used instead of Cre recombinase and loxP sites. Alternatively, in exemplary aspects, Tre recombinase and HIV markers are used in place of Cre and loxP sites.

[0041] In exemplary aspects, the recombinant expression vector system comprises a second suicide gene and the expression of the second suicide gene is activated when the cell expressing the recombinant expression vector system behaves similarly to or the same as a tumor cell or a cancer cell. In exemplary aspects, the expression of the second suicide gene is controlled by a telomerase promoter, e.g., a human telomerase promoter. In exemplary aspects, the expression of the second suicide gene is controlled by a promoter highly expressed in tumorigenic cells, e.g., BIRC5 (survivin). See, e.g., Blum et al., Nat Biotechnol 27: 281 -287 (2009). In exemplary aspects, the expression of the second suicide gene is controlled by a naturally occurring or native promoter. In exemplary aspects, the expression of the second suicide gene is controlled by synthetic version of said promoter or a hybrid combination of promoters (e.g., hTERT-CMV). See, e.g., Davis et al, Cancer Gene Therapy (2006) 13, 720-723).

[0042] As used herein, the term "suicide gene" refers to a gene that causes the cell expressing the suicide gene to die. The suicide gene can be a gene that confers sensitivity to an agent, e.g., a drug, upon the cell in which the gene is expressed, and causes the cell to die when the cell is contacted with or exposed to the agent. Suicide genes are known in the art (see, for example, Suicide Gene Therapy: Methods and Reviews. Springer, Caroline J. (Cancer Research UK Centre for Cancer Therapeutics at the Institute of Cancer Research, Sutton, Surrey, UK), Humana Press, 2004) and include, for example, the Herpes Simplex Virus (HSV) thymidine kinase (TK) gene, cytosine deaminase, purine nucleoside phosphorylase, and nitroreductase. In exemplary aspects, the first suicide gene or second suicide gene of the recombinant expression vector system is a heterologous enzyme that metabolizes an inactive prodrug into a cytotoxin. In exemplary aspects, the first suicide gene or second suicide gene is independently selected from the group consisting of: thymidine kinase (TK), guanine phosphororibosyl transferase, carboxypeptidase G2, purine nucleoside phosphorylase, cytosine deaminase-5-fluorocytosine, cytochrome P450-ifosfamide, cytochrome P450-cyclophosphamide, and nitroreductase-5-[aziridin-1 -yl]-2,4- dinitrobenzamide. In exemplary aspects, the first suicide gene is TK and the second gene is nitroreductase-5-[aziridin-1 -yl]-2,4-dinitrobenzamide, or nitroreductase. In exemplary instances, the TK gene comprises the sequence of SEQ ID NO: 29. In exemplary instances, the nitroreductase gene comprises the sequence of SEQ ID NO: 8.

[0043] In exemplary aspects, each vector of the recombinant expression vector system comprises a selectable marker. In exemplary aspects, the selectable marker is a gene product which confers resistance to an antibiotic, including but not limited to ampicillin, kanamycin, neomycin/G418, tetracycline, geneticin, triclosan, puromycin, zeocin, and hygromycin. In exemplary aspects, the selectable marker is selected from the group consisting of: kanamycin resistance genes, puromycin resistance genes, zeocin resistance genes, neomycin/G418 resistance genes, hygromycin resistance genes, histidinol resistance genes, tetracycline resistance genes, geneticin resistance genes, triclosan resistance genes, R-fluroorotic acid resistance genes, 5-fluorouracil resistance genes and ampicillin resistance genes. In exemplary aspects, when the system comprises more than one recombinant expression vector, each vector comprises a selectable marker. In exemplary aspects, each vector has the same selectable marker. Alternatively, each vector within the system comprises a different selectable marker.

[0044] In exemplary aspects, the recombinant expression vector comprises a nucleic acid encoding a tissue-specific promoter or hormone-responsive promoter; a nucleic acid encoding Cre recombinase; two loxP sites; a cytomegalovirus (CMV) promoter; a first suicide gene; a nucleic acid encoding a telomerase promoter (optionally hTERT (e.g., comprising SEQ ID NO: 28)); a second suicide gene; and a nucleic acid encoding a selectable marker. In exemplary aspects, the tissue-specific promoter or hormone- responsive promoter controls expression of Cre recombinase. In exemplary aspects, the Cre recombinase is encoded by a nucleic acid comprising the sequence of SEQ ID NO: 32. In exemplary aspects, the tissue-specific promoter is an insulin promoter and optionally comprises the sequence of SEQ ID NO: 31 . In exemplary aspects, the first suicide gene is located between the two loxP sites. In exemplary instances, each loxP site comprises the sequence of SEQ ID NO: 4 or 14. In exemplary aspects, the CMV promoter controls expression of the first suicide gene. In exemplary aspects, the CMV promoter comprises the sequence of SEQ ID NO: 6. In exemplary aspects, the first suicide gene is a thymidine kinase gene. In exemplary instances, the TK gene comprises the sequence of SEQ ID NO: 29. In exemplary aspects, the telomerase promoter controls expression of the second suicide gene. In exemplary aspects, the recombinase is Cre, but other recombinases could also be used, such as FLT

recombinase (FRT sites instead of loxP), Tre recombinase (using HIV markers instead of loxP) and others. In exemplary instances, the second suicide gene is a

nitroreductase gene, optionally, comprising the sequence of SEQ ID NO: 8.

[0045] In exemplary aspects, the recombinant expression vector system comprises the recombinant expression vectors shown in Figures 3 and 4. In exemplary aspects, the recombinant expression vector system comprises a recombinant expression vector comprising a sequence of SEQ ID NO: 1 (pUC57LoxNRNeoRLox) and/or SEQ ID NO: 2 (pPURHtertpTKHipCre). The sequences of the individual components of SEQ ID NO: 1 and 2 are shown in Figure 6. In exemplary aspects, the recombinant expression vector system comprises the recombinant expression vector shown in Figure 5.

[0046] Host cells

[0047] Also provided by the present disclosure is a host cell comprising any one of the recombinant expression vector systems described herein. As used herein, the term "host cell" refers to any type of cell that can contain the inventive recombinant expression vector system. The host cell can be a eukaryotic cell, e.g., plant, animal, fungi, or algae, or can be a prokaryotic cell, e.g., bacteria or protozoa. The host cell can be a cultured cell or a primary cell, i.e., isolated directly from an organism, e.g., a human. The host cell can be an adherent cell or a suspended cell, i.e., a cell that grows in suspension. In exemplary aspects, the host cell is a stem cell. In exemplary aspects, the host cell is a human stem cell. In exemplary aspects, the stem cell is a totipotent stem cell, a pluripotent stem cell or a multipotent stem cell. In exemplary aspects, the stem cell is an embryonic stem cell, a primordial germ cell, an adult stem cell (i.e., somatic stem cell, tissue-specific stem cell), or an induced pluripotent stem cell. In exemplary aspects, the stem cell is a mesenchymal stem cell (MSC) or a hematopoietic stem cell. In exemplary aspects, the MSC is an MSC from a pancreatic islet, a pancreatic ductal or acinar tissue, bone marrow, adipose tissue, amniotic fluid, umbilical cord or placenta. In exemplary aspects, the stem cell is a multipotent progenitor cell (MPP), a lineage-restricted progenitor cell (LRP), a common myeloid progenitor (CMP), a granulocyte-macrophage progenitor (GMP), or a megakaryocyte-erythroid progenitor (MEP). In exemplary aspects, the host cell is a human embryonic stem cells (hESc), a primordial germ cell, an induced pluripotent stem cells (iPSc), or a cell of a pluripotent cell type.

[0048] Also provided by the present disclosure is a population of cells comprising at least one host cell described herein. The population of cells can be a heterogeneous population comprising the host cell comprising any of the recombinant expression vectors described, in addition to at least one other cell. Alternatively, the population of cells can be a substantially homogeneous population, in which the population comprises mainly host cells (e.g., consisting essentially of) comprising the recombinant expression vector. The population also can be a clonal population of cells, in which all cells of the population are clones of a single host cell comprising a recombinant expression vector, such that all cells of the population comprise the recombinant expression vector. In one embodiment of the invention, the population of cells is a clonal population comprising host cells comprising a recombinant expression vector as described herein.

[0049] Kits

[0050] Kits comprising host cells or recombinant expression vector systems of the present disclosure are also provided. In exemplary embodiments, the kit comprises at least one agent which causes cell death to cells expressing a suicide gene. The kit in exemplary aspects comprises ganciclovir, if one of the suicide genes is thymidine kinase. In exemplary aspects, the kit comprises at least one agent which causes cell death to cells not expressing the selectable marker of the recombinant expression vector system. The kit in exemplary aspects comprises neomycin in the instance the system comprises a neomycin resistance gene. In exemplary aspects, the agent is selected from the group consisting of ampicillin, hygromycin, zeocin, puromycin, kanamycin, geneticin, triclosan, R-fluoroorotic acid or 5-fluorouracil.

[0051] In exemplary aspects, the kits comprise a unit dose of stem cells comprising the recombinant expression vector systems of the present disclosure. In exemplary aspects, the kit comprises a sterile, GMP-grade unit dose of the stem cells. In exemplary aspects, a unit dose of stem cells comprises 10 ⁵ , 10 ⁶ , 10 ⁷ , 10 ⁸ , 10 ⁹ , 10 ¹⁰ , 10 ¹¹ , 10 ¹² 10 ¹³ , or more than 10 ¹⁵ stem cells comprising the recombinant expression vector system of the present disclosure.

[0052] In exemplary aspects, the unit dose of stem cells is packaged in an

intravenous bag. In exemplary aspects, the unit dose of stem cells is provided in a cryogenic form. In exemplary aspects, the unit dose of stem cells is ready to use. In exemplary aspects, the unit dose of stem cells are provided in a tube, a flask, a dish, or like container.

[0053] Methods

[0054] Further provided is a method of producing stem cells suitable for

transplantation into a subject. In exemplary embodiments, the method comprising contacting a cell culture comprising stems cells with any one of the recombinant expression vector systems described herein and adding to the cell culture an agent which causes cell death to cells expressing a suicide gene or an agent which causes cell death to cells not expressing a selectable marker. In exemplary aspects, the method comprises contacting the cell culture with an agent which causes cell death to cells not expressing a selectable marker. In exemplary aspects, the agent is selected from the group consisting of neomycin, ampicillin, kanamycin, puromycin, hygromycin, zeocin, geneticin, triclosan, R-fluoroorotic acid or 5-fluorouracil.

[0055] Furthermore provided is a method of transplanting stem cells to a subject in need thereof, comprising administering to the subject stem cells comprising the recombinant expression vector system of the present disclosure and administering to the subject an agent which causes cell death to cells expressing a suicide gene. [0056] Methods of administering stem cells to a subject are well-known. See, e.g., Karussis et al., Arch Neurol 67(10): 1 187-1 194 (201 1 ); Kamani et al., Biol Blood Marrow Transplant ^) 1265-1272 (2012); Tedesco et al., Sci Transl Med 4: 149ra89 (2012); Bartlett, ST., et al. Report from IPITA-TTS Opinion Leaders Meeting on the Future of beta-Cell Replacement. Transplantation 100 Suppl 2, S1 -44 (2016); Schulz, T.C., et al. A scalable system for production of functional pancreatic progenitors from human embryonic stem cells. PLoS One 7, e37004 (2012); Dominguez-Bendala, J., et al. The Human Endocrine Pancreas: New Insights on Replacement and Regeneration. Trends Endocrinol Metab (2016); Kroon, E., et al. Pancreatic endoderm derived from human embryonic stem cells generates glucose-responsive insulin-secreting cells in vivo. Nat Biotechnol 26, 443-452 (2008); Stem Cells. 2013 Oct;31 (10):2047-60. doi:

10.1002/stem.1457; Concise review: clinical programs of stem cell therapies for liver and pancreas; Lanzoni G1 , Oikawa T, Wang Y, Cui CB, Carpino G, Cardinale V, Gerber D, Gabriel M, Dominguez-Bendala J, Furth ME, Gaudio E, Alvaro D, Inverardi L, Reid LM.

[0057] Without being bound to a particular theory, the administration, e.g.,

transplantation, of such stem cells with the recombinant expression vector of the present disclosure provides cells which differentiate into cells having therapeutic value. Thus, the administration, e.g., transplantation, of such stem cells with the recombinant expression vector of the present disclosure provides therapeutic treatment of the subject. Accordingly, the present disclosure provides methods of treating a disease in a subject in need thereof, comprising administering, e.g., transplanting, stem cells with the recombinant expression vector of the present disclosure in an amount effective to treat the disease. In exemplary aspects, the disease is a metabolic disease (e.g., diabetes), a liver disease, a neurodegenerative disease, an autoimmune disease, a cardiac disease, a genetic blood disease, cancer and the like.

[0058] The following examples are given merely to illustrate the present invention and not in any way to limit its scope. EXAMPLES EXAMPLE 1

[0059] This example demonstrates the construction of an exemplary vector system of the present disclosure.

[0060] The suicide gene cassettes shown in Figure 1 were synthesized base pair by base pair by GenScript (Piscataway, NJ) according to our design specifications. The vector was designed to contain Kozak sequences ³³ , terminator sequences and

enhancers as required for each unit of expression. Human codon usage optimization was also applied, as some of the mutant sequences used (such as NR T41 L/N71 S, which has 100x higher K _ca t/ m than the wild-type enzyme) contained codons that are infrequent in humans. Due to the size of the construct encompassing both suicide cassettes, for proof-of-principle purposes, it was decided to split the single vector into two separate plasmids that could be independently transfected: These were plasmid L (containing TelP-TK-hiP-Cre) and F (LoxP-CMV-NR).

[0061] The main elements of plasmid F are Lox P sites and Nitroreductase (NTR, T41 L/N71 S mutant). LoxP are 34 bp recombination sites from the bacteriophage P1 containing an asymmetric 8 bp flanked by two sets of palindromic 13 bp sequences. The Cre recombinase induces loxP-specific recombination. As a result of Cre activity, sequences flanked by loxP sites are excised out, leaving a single loxP site in place.

[0062] NTR is a flavoenzyme homodimer of 24 kDa subunits with tightly bound flavin mononucleotide (FMN) cofactors, encoded by the E. coli nsfB/nfnB gene. A variety of substrates, including CB1954 [5-(aziridin-1 -yl)-2,4-dinitrobenzamide] bind to the enzyme and get reduced by the FMN to a 4-hydroxylamino derivative, which in the presence of acetyl coenzyme A becomes a highly cytotoxic DNA inter-strand cross-linking agent ^{31 ,43} . Since virus-mediated expression of NTR in tumor cells sensitizes them to CB1954 in vitro and in vivo, this "suicide gene" strategy has been tested in human clinical trials for several types of cancer ^35, . Site-directed mutagenesis has been used to identify several mutants with enhanced kinetics of CB1954 activation, which may improve cell

sensitization to the pro-drug. Our construct contains the sequence of the double mutant T41 L/N71 S, kindly given by Professor P. F. Searle (University of Birmingham, UK).

T41 L/N71 S is a much faster enzyme at low CB1954 concentrations in vitro (100x higher Kcat/Km than the wild-type NfsB). In tumor cell lines, it sensitizes cells to CB1954 concentrations up to ~15-fold lower than the native enzyme (Prof. Searle, personal communication). Also, T41 L/N71 S preferentially reduces the 4-NO ₂ group of CB1954, which is more cytotoxic than 2-NO ₂ -reduction products. This makes the double mutant a superior enzyme for our purposes. In our construct, the T41 L/N71 S NTR gene is constitutively driven by the CMV promoter. This plasmid is selectable in Neomycin/G418. The neomycin resistance cassette is constitutively driven by the SV40 promoter. Upon Cre expression, both the NR and Neomycin resistance cassettes (which are in a region of the construct flanked by loxP sites) are eliminated.

[0063] The main elements of plasmid L are HSV thymidine kinase (HSV-TKSR39 mutant) and Cre. The thymidine kinase of the herpes simplex virus (HSV) helps viral DNA synthesis by adding a phosphate group to thymidine. The resulting dTMP is further phosphorylated to deoxythymidine di- and tri-phosphate, which is added to new viral DNA chains. However, HSV-TK can also phosphorylate nucleoside analogs such as aciclovir (ACV) and ganciclovir (GCV). Phosphorylation of GCV inside cells harboring the HSV-TK gene result in the accumulation of toxic metabolites, which eventually results in cell death ⁴⁴ . As with NTR, this system has also been safely tested in clinical trials for the treatment of cancer ^45,46 . Our construct features an enhanced mutant, HSV-TKSR39 ^47"49 (sequence kindly given by Dr. Qasim, UCL, UK), which has a higher activity at lower doses of the pro-drug ⁵⁰ . The HSV TK gene has been placed under the control of the human telomerase reverse transcriptase (hTERT) promoter, which drives the expression of hTERT in immortal cells ⁵¹ . Most somatic cells express it at very low levels or not at all, whereas hESc and most tumoral cells exhibit high levels of hTERT expression. As naturally occurring immature teratomas have high telomerase activity ⁴⁰ , it is expected that the placement of HSV-TK under the control of the telomerase promoter will lead to the selective expression of the suicide gene in carry-over undifferentiated hESc.

[0064] Cre is a site-specific recombinase from the bacteriophage P1 (see loxP above). In our construct design, expression of Cre will excise out the sequence comprised between the two loxP sites (NTR cassette). Since Cre is driven by the human insulin promoter (region -362 to +1 bp, which contains its key activation domains ⁵² ), these elements will be eliminated only in cells that express insulin upon differentiation, rendering them insensitive to CB1954.

[0065] Plasmid L is selectable in puromycin, and the resistance gene is driven by the SV40 promoter. Backbone sequences for both Plasmid R and L feature all the necessary elements for replication and expansion in bacterial hosts (including the ampicillin resistance marker). Throughout the entirety of this construct, we have been careful to add Kozak sequences ⁵³ wherever needed to ensure maximal expression in human cells. Terminator sequences and enhancers are also placed as required for each unit of expression. We have also applied human codon usage optimization during the synthesis of Tel-TK(NR)hiP-Cre. This precaution is especially important because some of the mutant sequences used (such as NR T41 L/N71 S) contain codons that are used rather infrequently in highly expressed human genes (P.F. Searle, personal communication).

EXAMPLE 2

[0066] This example demonstrates generation of a human embryonic stem cell line and in vitro testing thereof.

[0067] Clones of the hESc line H1 containing both constructs were selected using Puro (for plasmid L) and Neo (for plasmid F). We used electroporation of the linearized plasmids followed by Puro + Neo selection to achieve stable integration of both cassettes (λΗ1 ). Integration was confirmed by PCR, and positive clones were expanded and stocked in liquid N ₂ . -25 double resistant clones were handpicked, expanded under antibiotic selection and frozen in liquid N ₂ . A typical undifferentiated colony of one such clone, propagated in Puro + Neo to maintain selective pressure, was imaged. In their undifferentiated state, such clones have been shown to be sensitive to both CB1954 and GCV. Aliquots were screened by genomic PCR to confirm the integration of both constructs (data not shown). qRT-PCR was performed to determine which clones had higher transgene (HSV-TK and NTR) expression. Clone A (H1 .1 from now on) was selected for further testing based on the results of these assays. A kill curve using different dosages for GCV (0.01 to 1000 μΜ) and CB1954 (0.1 to 300 μΜ) was done for H1 .1 . Cell death was quantified by MTT assays on H1 .1 and the parental wild-type H1 line. These assays helped us determine the optimal concentration of each pro-drug that leads to complete ablation of undifferentiated H1 .1 cells while preserving the viability of the parental line within 7 days. Such concentration was in the range of 10-100 μΜ for GCV and 50-100 μΜ for CB1954, as previously reported in the literature for other cell types ^26,54,55 . The integration of these constructs had no detectable effects in terms of pluripotency marker expression (TRA-1 -60, SSEA3, SSEA4, Oct3/4, Nanog) vs. the unmodified parental line H1 , as determined by qRT-PCR, immunofluorescence and FACS analyses (data not shown). Fig. 2 (right column) shows H1 .1 cells after 7 days of GCV (top row) or CB1954 (bottom row) selection. Unmodified parental clones (left column) remain largely unscathed by these treatments at the same time point.

EXAMPLE 3

[0068] This example demonstrates additional studies relating to the vectors of the present disclosure.

[0069] The aim of the first study will be to assess the ability of our suicide switches, e.g., Tel-TK(NR)hlP-CRE, to control non-specific differentiation and tumorigenic proliferation. Stable suicide gene-equipped clones in additional hESc line (Wicell's H9) and two iPSc lines (DF19-9-1 1 T.H and DF4-3-7T.A, also from WiCell) are generated in order to demonstrate the repeatability of our strategy. The modified lines are

karyotyped and it is confirmed that undifferentiated clones are GCV- and CB1954- sensitive. Next, their differentiation into pancreatic endocrine cells is induced. While the most recent state-of-the art protocols ⁵ are followed in this study, earlier versions that yield a mix of insulin ⁺ cells, other differentiated cell types and cells that form teratomas when implanted in rodents ⁴ also are deliberately followed. The differentiated cells in vitro with both pro-drugs are challenged. The expected outcome is the ablation of all insulin ^" and telomerase ⁺ cells by CB1954 and GCV, respectively. This outcome is quantified against unchallenged controls. Differentiated cell products, prior to and after selection, are submitted to the Beta-Cell Function Analysis Lab at the U. of Illinois in Chicago for beta-cell phenotype verification. [0070] The aim of the second study is to design and test similar constructs based on pan-endocrine promoter selectivity (Isl1 , synaptophysin). While the aim of the first study is designed to establish proof of principle, the presence of other non-beta endocrine cell types in the graft is widely perceived as important for the fine-tuning of glucose metabolism. By replacing the insulin promoter by pan-endocrine ones such as synaptophysi, Isl1 , or chromogranin, the approach described herein will allow for the selective survival of endocrine cell types.

[0071] The aim of the third study is to integrate the above constructs into the

ROSA26 locus of selected hPSC lines by CRISPR/Cas9 gene editing techniques. Once function has been proven, our next endpoint is to target these constructs into a known location of the human genome: (a) whose targeting does not result in harmful insertional mutagenesis (especially of tumor-suppressor genes); (b) that supports adequate transgene expression; and (c) that can be targeted with relative ease. ROSA26 is a locus that satisfies all the above criteria, and as such has been extensively used for targeted transgene integration in mice ⁴⁴ and hESc ⁴⁵ . hROSA26 has a sequence similarity of >85% with its mouse counterpart. It maps to a non-coding region of the DNA (THUMPD3-AS1 ), of which three variants have been described, transcribing long non-coding RNAs. However, since there have been two updates in the human genome database since the hROSA26 region was first published ⁴⁵ , there is a need to re-define what would be a safe harbor region for ectopic integration. Remarkably, within the 1220 bp region first identified, now lie the exons for the THUMPD3-AS1 gene in the negative sense strand and the first exon of the SETD5 gene in the positive strand. We posit that the region between these two exons is safe for integration of external sequences. Thus, we propose to target the region at chr3:9,397,494-9,397,698 (GRCh38.p7 2013 library). gRNAs will be designed to target this stretch of 205 bp, which does not contain any gene or known regulatory site.

[0072] Experimental plan: (a) gRNA design. Using the CRISPR tool developed by Dr. F. Zhang and available at the crispr.mit.edu website, we designed gRNAs to target the above region. Out of 57 gRNAs analyzed, we chose 3 with the best score (92, 94 and 95) and least predicted off-target cutting. The plasmid used for Cas9 expression is pX330-U6-ChimericBBCBhh-SpCas9 (Addgene). It contains an easy-to-incorporate sgRNA site flanked by Bbsl restriction sites. We will also add an eGFP cassette for sorting of Cas9 ⁺ cells. Our lab uses a modified protocol that allows for colony formation from single cells without differentiation, (b) Donor plasmid design. A donor plasmid will be designed for a region flanking the 3 proposed cut sites. It is recommended (Dr.

Zhang, personal communication) that the homology directed repair (HDR) flanking arms should be homologous to a site <100 bp away from the target. Our HDR arms will have homology to the flanking regions 800 bp to each side of the cut site of our 1 ^st gRNA. We have designed a pUC19-hROSA26-HDR plasmid consisting of a 1 .6 kb HDR region, with 10 restriction sites in the middle. This will allow for subcloning of L and F

sequences in independent donor plasmids. hESc electroporation with the Cas9 plasmid will allow for eGFP ⁺ sorting, followed by transfection with donor plasmids for hROSA26- directed knock-in (methods further described in ⁴⁶ ). Knock-in verification. We have designed surveyor primers specific to our HDRs. PCR amplification of genomic DNA showing amplicons of the predicted size will confirm specific knock-ins within hROSA26. Since Plasmid L and F sequences are in independent donor plasmids, we will screen for their insertion into each of the two alleles of the locus.

[0073] The aim of the fourth study is to perform in vivo tests of function in rodents. The ultimate goal is to confirm the approach in vivo, and, in particular, to characterize the method with respect to already formed tumors . To that end, the following groups of hPSC and/or derivatives are transplanted under the kidney capsule of immunodeficient (SCID/beige) mice: (1 ) Targeted undifferentiated cells (to perform straight teratoma formation assays and test their elimination by oral pro-drug administration 1 -2 months after transplantation); (2) Targeted cells after in vitro differentiation and pro-drug selection; (3) Targeted cells after in vitro differentiation without pro-drug selection (after 1 month, one sub-group will receive both pro-drugs and a second sub-group will not receive any).

EXAMPLE 4

[0074] This example demonstrates an exemplary recombinant expression vector system of the present disclosure. [0075] The directed differentiation of human embryonic stem (huES) cells into islet cell types offers great promise, especially in view of the clinical success of islet transplantation for type I diabetes (1 ). However, transplantation of ES cell-derived tissues often results in the generation of tumors (teratomas) in animal models. Such concern would make this technology unusable for human therapy. It is desirable to devise alternative approaches for the selective ablation of those grafted cells that retain unlimited proliferation potential, while preserving the postmitotic ones. An even more specific level of selection would allow for the ablation, pre- or post-transplantation, of every cell not specific of the tissue of interest (e.g., insulin-positive cells).

[0076] A new construct has been designed to this effect. Figure 5 is a schematic diagram of an exemplary construct. Stable transfection of such construct into any type of embryonic stem cell is expected to result in the molecular implementation of controls to avoid (a) non-specific differentiation and (b) uncontrolled proliferation.

[0077] Such cell line is used to derive insulin-producing cells by means of existing protocols. Successful differentiation results in the activation of the insulin promoter (RIP) and subsequent expression of the Cre recombinase. The 'floxed' CMV-TK cassette is excised in those cells that express insulin, but not in other cell by-products. Hence, ganciclovir selection could be applied prior to transplantation to get rid of undesired, non-specific tissues (TK+).

[0078] Insulin expression is usually associated to a state of terminal differentiation. Although beta cells do replicate in adult life (2), there is no evidence that such

replication is accompanied by a re-activation of the telomerase gene. Therefore, ganciclovir selection (3) should result in the ablation of any undifferentiated escapee. However, from a safety standpoint, there are two hypothetical possibilities that cannot be ruled out: (a) The generation of semi-differentiated intermediates which, despite producing insulin (and therefore becoming ganciclovir-insensitive), are still locked in a proliferative mode; and (b) Spontaneous reversion of insulin-producing cells (already TK-) to a more undifferentiated, cycling stage. [0079] Based on safety grounds, such theoretical concerns would still preclude the clinical transplantation of huES cell-derived insulin-producing cells. For this reason, we have included a secondary protective measure (telomerase-gpt) in the design of the construct. Telomerase expression is a common denominator of active tumors, including immature teratomas generated from undifferentiated stem cells (4). Grafted cells with teratogenic potential (telomerase-positive) that have escaped ganciclovir pre-selection could still be ablated in vivo by oral administration of 6-TX (5).

[0080] By changing the tissue-specific promoter used in this particular application (RIP), this vector can be customized to generate cell lines designed for any specific lineage of interest. For instance, using a liver-specific promoter (e.g., albumin), any cell not terminally differentiated into a hepatocyte could be ablated in vitro or in vivo.

Similarly, any teratogenic escapee could be ablated in vivo upon transplantation.

EXAMPLE 5

[0081] This example demonstrates a double fail-safe approach to prevent

tumorigenesis and select pancreatic β-cells from human embryonic stem cells.

[0082] Pancreatic islet transplantation is an effective cell therapy for type 1 diabetes (T1 D), but its clinical application is limited by the shortage of donor pancreata. Among the potential alternatives, the differentiation of human embryonic stem cells (hESc) into insulin-producing β-cells has taken an early lead. However, while the proportion of β- cells obtained through current methods is relatively high, a significant percentage of undefined non-endocrine cell types are still generated. Most importantly, there is the potential for carry-over of non-differentiated cell types that may produce teratomas upon transplantation. In order to address these issues, we sought to modify hESc so that their differentiated progeny could be selectively devoid of tumorigenic cells and enriched for cells of the desired phenotype (in this case, pancreatic β-cells). Here we report the generation of a modified H1 hESc line (AH1 ) harboring two stably integrated suicide gene cassettes, whose expression results in cell death in the presence of specific prodrugs. The first one (HSV thymidine kinase, HSV-TK) is only active in telomerase- expressing cells, whereas the second (nitroreductase, NTR) is selectively excised out of the genome in insulin-expressing cells. The pro-drugs ganciclovir (GCV) and CB1954 kill cells that express HSV-TK or NTR, respectively. We show the efficacy of this system at enriching for β-cells and eliminating tumorigenic ones both in vitro and in vivo. Our approach is innovative inasmuch as it allows for the preservation of the desired cells while eliminating those with the potential to develop teratomas. hESc derivatives with these safeguard mechanisms would be deemed safe for transplantation in humans.

[0083] Introduction

[0084] Progress on the directed differentiation of human embryonic stem cells (hESc) has finally led to their clinical implementation: the website at clinicaltrials.gov lists multiple clinical trials in which hESc are used for conditions ranging from macular degeneration to type 1 diabetes. For the latter, Phase l/l I studies have already been initiated based on promising preclinical data showing diabetes reversal after

transplantation of hESc-derived pancreatic progenitor cells that further mature in vivo into insulin-producing p-cells(1 ). Functional β-like cells differentiated from hESc using the latest protocols are already lining up in the clinical pipeline (2, 3). However, for all its clinical promise, this approach is not without limitations. While the proportion of β-like cells obtained through state-of-the-art terminal differentiation methods is relatively high (30-40%)(2, 3) a significant percentage of undefined non-endocrine cell types are also generated (2, 4). Most importantly, there is the potential for carry-over of non- differentiated cell types that may produce teratomas upon transplantation(5). Although refinements of the prevailing differentiation protocols have significantly reduced this risk in preclinical studies, the foreseeable implementation of hESc-based therapies in thousands of patients calls for caution. One single case of hESc-derived tumors in patients may set the entire field back for years. To address this concern, we set out to engineer a hESc line with control mechanisms allowing for the selective ablation of both tumorigenic cells and cells differentiated along non-desired fates. We hypothesized that constructs of our invention, when stably integrated within the host cell line genome, would impart such selectivity. Given its clinical immediacy, we decided to focus on a model of differentiation for the treatment of diabetes (insulin-producing cells), even though our system could be customized for any cell type of choice. In such model, the control mechanisms are based, respectively, on (a) the activation of a suicide gene (herpes simplex virus thymidine kinase, or HSV-TK) in cells that resume/continue tumorigenic proliferation; and (b) the irreversible inactivation of a second suicide gene (nitroreductase, NTR) in cells that express insulin. These genes impart sensitivity to ganciclovir (GCV)(6) and CB1954(7), respectively, which have been safely tested in numerous clinical trials(8)'. In our construct design, the NTR cassette, flanked by loxP sites, is excised upon expression of Cre by the human insulin promoter(9). Therefore, cells that express insulin are rendered insensitive to CB1 954. The HSV-TK gene is placed under the control of the telomerase promoter, which is active only in

undifferentiated cell types(10). This makes proliferating cells sensitive to GCV. Thus, our method provides a double fail-safe control such that (1 ) only insulin ⁺ , non- proliferating cells survive selection in vitro; (2) cells that may de-differentiate after transplantation^ 1 ) (and in which NTR was lost with the onset of insulin expression) can be still be selectively killed in vivo by GCV, leaving the rest of the graft intact; and (3) undifferentiated cells are sensitive to two pro-drugs, making it less likely for tumorigenic cells to survive in case one single drug was insufficient to destroy 100% of them. No other method reported thus far offers the same degree of safety and specificity, as conventional suicide gene-based strategies bring about the destruction of the entire graft. Our results offer proof of principle of this novel approach and open the door to the subsequent targeting of these constructs to specific "safe harbor" locations within the genome of clinical-grade hESc.

[0085] Results

[0086] Suicide cassette composition

[0087] Suicide gene cassettes were synthesized base pair by base pair by GenScript (Piscataway, NJ) according to our specifications. Owing to the size of the construct encompassing both suicide cassettes, we decided to split it into two constructs that could be independently transfected. Fig. 6 shows the composition of constructs A (containing LoxP-CMV-NTR-LoxP) and B (containing hTERTP-HSV-TK-hiP-Cre), as well as their predicted function. The main elements of construct A are: (a) LoxP sites. LoxP are 34 bp recombination sites from the bacteriophage P1 containing an asymmetric 8 bp flanked by two sets of palindromic 13 bp sequences. The Cre recombinase induces loxP-specific recombination. As a result of Cre activity, sequences flanked by loxP sites are excised out, leaving a single loxP site in place(12). (b)

Nitroreductase (NTR, T41 L/N71 S mutant). NTR is a flavoenzyme homodimer of 24 kDa subunits with tightly bound flavin mononucleotide (FMN) cofactors, encoded by the E. coli nsfB/nfnB gene(13). A variety of substrates, including CB1954 [5-(aziridin-1 -yl)-2,4- dinitrobenzamide] bind to the enzyme and get reduced by the FMN to a 4- hydroxylamino derivative, which in the presence of acetyl coenzyme A becomes a highly cytotoxic DNA inter-strand cross-linking agent(7). Since virus-mediated

expression of NTR in tumor cells sensitizes them to CB1954 in vitro and in vivo, this "suicide gene" strategy has been tested in human clinical trials for several types of cancer(8, 13). Site-directed mutagenesis has been used to identify several mutants with enhanced kinetics of CB1954 activation, which may improve cell sensitization to the pro-drug. Our construct contains the sequence of the double mutant T41 L/N71 S, kindly given by Professor P. F. Searle (University of Birmingham, UK). T41 L/N71 S is a much faster enzyme at low CB1954 concentrations in vitro (100x higher K _ca t/Km than the wild- type nfsB). In tumor cell lines, it sensitizes cells to CB1954 concentrations up to -15- fold lower than the native enzyme (Prof. Searle, personal communication). Also, T41 L/N71 S preferentially reduces the 4-NO2 group of CB1954, which is more cytotoxic than 2-NO ₂ -reduction products. In our construct, the T41 L/N71 S NTR gene is

constitutively driven by the CMV promoter. This plasmid is selectable in

Neomycin/G418. The neomycin resistance cassette is constitutively driven by the SV40 promoter. Upon Cre expression, both the NTR and Neomycin resistance cassettes (which are in a region of the construct flanked by loxP sites) are eliminated (fig. 6).

[0088] The main elements of construct B are: (a) HSV thymidine kinase (HSV- TKSR39 mutant). The thymidine kinase of the herpes simplex virus (HSV) helps viral DNA synthesis by adding a phosphate group to thymidine. The resulting dTMP is further phosphorylated to deoxythymidine di- and tri-phosphate, which is added to new viral DNA chains. However, HSV-TK can also phosphorylate nucleoside analogs such as aciclovir (ACV) and ganciclovir (GCV). Phosphorylation of GCV inside cells harboring the HSV-TK gene result in the accumulation of toxic metabolites, which results in cell death(14). As with NTR, this system has also been safely tested in clinical trials for the treatment of cancer(15, 16). Our construct features an enhanced mutant, HSV- TKSR39(17) (sequence kindly given by Dr. Qasim, UCL, UK), which has a higher activity at lower doses of the pro-drug(18). This gene has been placed under the control of the human telomerase reverse transcriptase (hTERT) promoter, which drives the expression of hTERT in immortal cells. Most somatic cells express it at very low levels or not at all, whereas hESc and most tumoral cells exhibit high levels of hTERT expression. As naturally occurring immature teratomas have high telomerase activity(10), it is expected that the placement of HSV-TK under the control of the telomerase promoter will lead to the selective expression of the suicide gene in carry-over undifferentiated hESc. (b) Cre is a site-specific recombinase from the bacteriophage P1 (see loxP above) (12). In our construct design, Cre will excise out the sequence comprised between the two loxP sites (NTR cassette). Since Cre is driven by the human insulin promoter (region - 362 to +1 bp, which contains its key activation domains(19)), these elements will be eliminated only in cells that express insulin upon differentiation, rendering them insensitive to CB1954 (Fig. 6).

[0089] Construct A is selectable in puromycin, and the resistance gene is driven by the SV40 promoter. Backbone sequences for both constructs A and B feature all the necessary elements for replication and expansion in bacterial hosts (including the ampicillin resistance marker). Throughout the entirety of this construct, we were careful to add Kozak sequences(20) wherever needed to ensure maximal expression in human cells. Terminator sequences and enhancers are also placed as required for each unit of expression. We also applied human codon usage optimization during the synthesis of each construct. This precaution is especially important because some of the mutant sequences used contain codons that are used rather infrequently in highly expressed human genes (P.F. Searle, personal communication). The sequence of both constructs are provided in the sequence listing.

[0090] Modified hESc express the transaenes and maintain pluripotencv [0091] Clones of the hESc line H1 containing both constructs could be selected using puromycin (for A) and neomycin (for B). We used electroporation of the linearized plasmids followed by puromycin + neomycin selection to achieve stable integration of both cassettes. This cell line was therefore equipped with both suicide cassettes

[hTERT-HSV-TK and (CMV-NTR)hlP-Cre]. Twenty six double resistant clones were handpicked, expanded under antibiotic selection and frozen in liquid N ₂ . Aliquots were screened by genomic PCR to confirm single-copy integration of both constructs. qRT- PCR was performed to determine which clones had higher transgene (HSV-TK and NTR) expression. Clone A {AH1 from now on) was selected for further testing based on the results of these assays. As shown in Fig. 7a, AH1 cells express both the NTR and HSV-TK transgenes. Both the morphology of AH1 colonies (Fig. 7b) and their pattern of expression of pluripotency markers [as determined by flow cytometry (Figs. 7c, d), qRT- PCR (Fig. 7e) and immunofluorescence (Fig. 7f)] were largely indistinguishable from those observed in the parental (unmodified) H1 cell line.

[0092] AH1 cells are sensitive to both ganciclovir and CB1954 in vitro

[0093] A kill curve using different dosages for GCV (0.01 to 1000 μΜ) and CB1954 (0.1 to 300 μΜ) was done for AH1 and the parental H1 lines. Cell death was quantified by MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assays, which helped us determine the optimal concentration of each pro-drug that leads to ablation of undifferentiated KH1 cells while preserving the viability of the parental line within 7 days. Such concentration was in the range of 10-100 μΜ for both GCV and CB1954 (Fig. 8a), as previously reported in the literature for other cell types (21 , 22). We used 10 μΜ for CB1954 and 100 μΜ of GCV for all subsequent experiments. Fig. 8b shows the viability curve of both AH1 and H1 cells when exposed to the above pro-drug dosages for 7 days. As shown in Fig. 8c, the parental H1 line is largely insensitive to either pro-drug, while most KH1 cells die just after 3 days of exposure to CB1954 and 7 days of exposure to GCV.

[0094] AH1 cells are as competent as their parental line to differentiate along the β- cell lineage [0095] Next, we proceeded to differentiate both AH1 and its parental cell line into β- like cells as described in Example 6. An outline of the stages of this protocol (DE:

definitive endoderm; PF: posterior foregut; PE: pancreatic endoderm; PLC: β-like cells) is shown in fig. 9a.

[0096] Differentiation of AH1 and H1 cells was completed as indicated above. The gene expression pattern, as determined by qRT-PCR of a panel of representative genes at each stage, shows no statistical differences between AH1 and H1 cells at any of the stages analyzed (Fig. 9b). The percentage of the pancreatic progenitor markers PDX1 ⁺ and NKX6.1 ⁺ at the end of stage 4 (PE), which is used as a quality control for preparations prior to the last differentiation step (28), was similar for both the modified and the parental cell line (46.4 vs. 47.6 %, respectively), and in line with previously reported results (2, 3, 27).

[0097] Representative immunofluorescence results at the different stages of differentiation (from PF onwards) are shown in Fig. 9c. The bottom-right picture shows a magnified detail of the insulin staining at the last stage. Of note, although we typically use C-peptide instead of insulin antibodies to make sure that the insulin is being produced and secreted by the cells and not taken up by the medium (29), in this particular case we trust the accuracy of insulin staining given that insulin is absent in all the defined media used throughout differentiation.

[0098] Suicide constructs function as predicted after β-cell differentiation in vitro

[0099] Once differentiation was completed, we exposed cultures of both cell lines to CB1954 and GCV (10 and 100 μΜ, respectively) for 7 additional days, and analyzed the resulting populations by flow cytometry (n=3 independent experiments). Controls were kept in the same conditions, untreated, for the same length of time. As shown in fig. 10a (top, left), the percentage of live AH1 cells that co-express PDX1 and NKX6.1 differs significantly between the untreated (38.3 ± 6.3 %, black column, left) and the treated (85.2 ± 4.7 %, black column, right) (P=0.0001 ). As it can be argued that PDX1 and NKX6.1 are also markers of undifferentiated β-cells, we further interrogated these populations for the marker combination PDX17NKX6.17INS ⁺ , which represents a widely accepted β-cell signature (2, 3, 27). The same pattern held true, as shown in Fig. 10a (top, right): 29.6 ± 7.5 % of untreated vs. 81 .7 ± 6.4 % of treated cells (P=0.004). As for the parental H1 line, there were no statistically significant differences between treated and untreated groups (Fig. 10a, bottom). To discard the possibility that the pro-drugs may negatively affect the phenotype of the selected β-like cells, we conducted a qRT-PCR analysis of key pancreatic endocrine genes at the conclusion of the experiment, for both treated and untreated AH1 and H1 cells. This analysis is presented in Fig. 10b. As expected, the parental line showed no significant differences in the expression of any of the studied genes between treated (red columns) and untreated (dark red) cells.

Untreated AH1 cells (black columns) also exhibited the same pattern. In contrast, and surprisingly, the expression of insulin, the potassium channel subunit Kir6.2, the sulfonylurea receptor Sur1 , and the zinc transporter SLC30A8 (all involved in the secretion of insulin by the β-cell) was significantly upregulated in the KH1 cells that received both pro-drugs (grey columns) vs. the untreated ones. These results suggest that, far from exerting a deleterious effect on the function of β-cells, selection and enrichment by the pro-drugs may in fact improve it. Furthermore, RNAseq analysis of pro- drug-selected cells indicates a high degree of hierarchical correlation with isolated pancreatic islets, but not with undifferentiated hESc (Fig. 10c). The comparison of specific pancreatic markers between islets and A -/7-derived and selected β-like cells (Fig. 10d) further confirms the overall similitude of their transcriptional profile. Taken together, our data present evidence that: (1 ) AH1 cells are sensitive to both GCV and CB1954 when undifferentiated; and (2) treatment with the prodrugs upon differentiation induces a significant β-cell enrichment.

[00100] Treatment with either GCV or CB1954 prevents the formation of and eliminates fully formed teratomas in immunodeficient mice xenotransplanted with AH1 cells

[00101] In order to test whether our suicide gene strategy works as intended in vivo, 5 x 10 ⁶ undifferentiated KH1 cells were transplanted subcutaneously in the left posterior dorsal flank of 5-6-week-old immunodeficient NOD-SCID mice. These conditions are known to result in the formation of teratomas within 6-9 weeks. Groups were assigned as follows:

1 . Control (no treatment): 3 mice

2. Peri-transplantation treatment with GCV (40 mg/kg of body

weight; 5 days, starting the 7 ^th day after transplantation): 4 mice

3. Peri-transplantation treatment with CB1954 (20 mg/kg of body

weight; 5 days, starting the 7 ^th day after transplantation): 4 mice

[00102] As described in the literature, tumors could be manually palpated and measured using calipers in the control group starting at week 6-7. At week 10, one of the mice was euthanized for histopathological characterization of the teratoma. Starting on week 1 1 , we treated the remaining two mice with a combination of GCV and CB1954 to test the hypothesis that pro-drug administration would eliminate already formed tumors. As shown in Figure 1 1 a, this was indeed the case, as tumor volume recessed to near undetectable levels within 2 weeks of treatment (experiments still ongoing)

[00103] No tumors could be detected in the ganciclovir-pretreated group up to week 10, 4 full weeks after tumors were first detected in the control group. Two mice in this group were euthanized at this point, showing no evidence of tumors (data not shown). However, manual palpation of the other two mice suggested the presence of very small teratomas, so we observed them for an additional week. During this period, the tumors grew significantly in both mice. This could be due to either the carry-over of residual hESc escapees that survived the initial GCV regimen, or to the development of GCV- resistant mutations in HSV-TK, as described in the literature. To test these two hypotheses, we re-treated these animals with ganciclovir in a 5-day drug/2-day rest regimen for the following two weeks. If the reason for the appearance of these late- onset tumors was resistance to the drug, we should continue to observe tumor growth despite the treatment; in contrast, if they were derived from surviving escapees, we might see tumor recession. Indeed, as shown in Fig. 1 1 b, after a 2-week course of GCV re-treatment, both tumors virtually disappeared. This result is especially remarkable when considering that one of the mice had a very large tumor (>250 mm ³ ) at the initiation of the treatment. Finally, none of the animals in the third group (treated in the peri-transplantation period with CB1954) showed signs of tumor formation 1 1 weeks into the follow-up.

[00104] Discussion

[00105] It has been argued that, provided that the number of undifferentiated cells/batch is below the threshold known to produce teratomas in immunodeficient mice, hESc preparations are safe for transplantation(30). However, this strategy is based on statistical predictions, and does not take into account the risk of de-differentiation after engraftment (1 1 ). hESc-based therapies are predicted to reach millions. It would take only one incidence of tumorigenesis to bring the entire field to a screeching halt, perhaps for years. It is for this reason that key industry players are keen on adopting additional safeguards going to the clinic (see attached letters of support from Roslin Cells Ltd. and Semma Therapeutics). To this end, the use of suicide genes under constitutive promoters has been proposed (22). However, the pro-drug would kill the whole graft, including the cells for which there was a need in the first place. Considering the frequency at which teratogenic lesions are observed in some conditions, such safeguard would render the approach impractical. More recently, an hTERT-driven HSV-TK adenoviral transduction approach has been used with success for preclinical treatment of renal cell carcinoma(31 ). These findings reinforce the validity of our approach but do not replace it. Our method is innovative because it allows for the selective preservation and enrichment of the desired cells while destroying those with tumorigenic potential. The provision of a double failsafe mechanism is another novelty of our system, as tumorigenic escapees would be sensitive to not one but two prodrugs. To our knowledge, no similar tactic has been described thus far. Also, as we intend to target the integration of this construct into a safe genomic harbor, the risks of insertional mutagenesis(32) are minimized. This has not been accomplished to date either. hESc lines modified in this fashion would be considered safe for transplantation. The BIRC-5-GLuc reporter system is novel as well and will potentially streamline the necessary preclinical testing of the cell lines herein discussed. Finally, even if the experiments herein proposed are based on β-cell differentiation, our strategy will also be adapted for pan-endocrine cells (specific aim 2) in order to preserve the cross-talk between the different endocrine cell types that arise upon directed hESc

differentiation^). If successful, our strategy has far-reaching applications beyond diabetes. Selectivity could be adjusted for many other settings by simply replacing the insulin promoter by regulatory sequences specific to the cell type of interest (e.g., albumin promoter for hepatocytes, PNR promoter for retinal photoreceptor cells, GFAP for glial cells, etc.).

EXAMPLE 6

[00106] This example demonstrates the methods and materials used in the experiments described in Example 5.

[00107] Cell Culture, differentiation and MTT growth assays

[00108] hESc (H1 , National Stem Cell Registry #WA01 , passage 35-45) were cultured as described in Schuldiner et al., PNAS USA 97: 1 1307-1 1312 (2000) using imTeSR™ (STEMCELL Technologies, Vancouver, Canada). The cells were

differentiated along the β-cell lineage using a variation of our published protocol (Cechin et al., Stem Cells Translational Medicine 3: 277-289 (2014), which in turn is an adaptation of Razania et al., Nat Biotechnol 32: 1 121 -1 133 (2014). In our version, the last maturation step is conducted in perfluorocarbon (PFC)-based dishes that provide a bi-directional oxygenation pattern to pancreatic progenitors. Such pattern has been shown to minimize O2 diffusion gradients and hypoxia in 3D aggregates, while accurately targeting the β-cell physiological pO ₂ range. A second variation is the removal of commonly used BMP inhibitors, as recently reported by Russ and

colleagues. MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide) is a reagent which is converted from a soluble tetrazolium to its insoluble formazan form via the activity of mitochondrial NAD(P)H-dependent oxidoreductase activity. This can be used to evaluate growth and proliferation of hESC colonies. MTT growth assays were performed for the sensitivity of transfected colonies to neomycin, puromycin, GCV and CB1954 at varying concentrations as previously described.

[00109] Codon optimization, vector construction and plasmid transfection [00110] Cre recombinase (Cre), Herpes Simplex Virus Thymidine Kinase SR39 mutant (HSV-TKSR39) and Nitroreductase mutant T41 L/N71 S (T41 L/N71 S-NTR) coding sequences were codon-usage optimized in silico to increase eukaryotic translational efficiency. This was performed using the OptimumGene™ Codon

Optimization by GenScript (Piscataway, NJ). Both suicide cassette sequences were synthesized using custom gene synthesis at GenScript. Construct A is 3665 bp and the sequence comprises a LoxP site followed by a CMV enhancer and promoter site, the T41 L/N71 S-NTR sequence, a poly(A) signal, a SV40 promoter, aminoglycoside phosphotransferase gene, a SV40 poly(A) signal and a LoxP site. This sequence was subcloned into a pUC57 backbone (GenScript) using BstEII/Notl. Construct B is 4996 bp and is comprised of a human telomerase gene promoter, the HSV-TKSR39 sequence, a poly(A) signal, the human insulin promoter, Cre recombinase, Myc tag, β- globin poly(A) signal, the SV40 promoter, puromycin N-acetyltransferase gene and a SV40 poly(A) signal. This sequence was subcloned into a pPUR backbone (Clontech, Mountainview, CA) using BamHI/Sapl. Constructs A and B were linearized using Sspl and BamHI, respectively, and purified on a 2% agarose gel. The linearized plasmid was retrieved from the agarose using the QIAquick™ Gel Extraction Kit and the QIAquick™ PCR purification kit, both from Qiagen (Germantown, MD). AT75 flask was coated with hESC-qualified Matrigel matrix solution comprising of 255 μΙ of Matrigel™ Matrix (Cat# 354277, Lot# 600473) (Corning, Corning, NY) for 2 hours, and then washed three times with cold Dulbecco's Phosphate Buffered Saline (DPBS, Sigma-Aldrich, St. Louis, MO). H1 hESc were cultured until 70% confluent and then disassociated using the enzyme- free disassociation buffer ReLeSR™(STEMCELL Technologies). Cells were carefully centrifuged at 300 rcf for five minutes, washed in DPBS and counted using 4% Trypan blue. Approximately 5 million cells were then resuspended in 800 μί transfection buffer containing mTeSR, HEPES buffer 10mM and 40 g linearized DNA. The cell suspension was then placed in a pre-chilled sterile Gene Pulser® cuvette (Bio-Rad, Hercules, CA). The cuvette's edges were wiped clean and then placed in the shocking chamber of a Bio-rad Gene Pulser® II Electroporation System. Voltage was set at 286V, high capacitance at 200 F and maximum high capacitance to allow 500V. Following electroporation, the cells were then placed in fresh mTeSR containing 10mM Y-27632 dihydrochloride (Sigma, Cat# Y0503), and plated onto a Matrigel-coated 100 mm x 15 mm dish. After 24 hours, the cells were challenged with l OOpg/iml neomycin (Sigma, Cat# N1 142) for Construct A. Resistant colonies were picked and passaged 6 times. PCR was used to determine construct integration and expression. Select expanded clones underwent a second electroporation procedure with Construct B. Stable integrants were selected using 3 g/ml puromycin (Sigma, Cat# P9620). 26 clones generated were assessed for the integration and expression of both constructs after 6 passages. Subsequently, all the clones were frozen and stored at -196 ^Q C in liquid Nitrogen cryotanks.

[00111 ] Fluorescence-Activated Cell Sorting (FA CS) Analysis

[00112] FACS analyses of hESc and the hESc-derived differentiation products were performed on the FACSCalibur system (Becton Dickinson; Franklin Lakes, NJ). SSEA4, TRA160R, SSEA3, Insulin, NKX6.1 and PDX1 . Details on the antibodies used in these analyses as well as their dilution are provided in Table 1 . Isotype controls were used to set background fluorescence. Analyses were completed using Kaluza FACS analysis software (Beckman Coulter, Brea, CA).

TABLE 1

Antibody to Concentration Host Company Cat Reactivity

IF FACS number to Human

SSEA3-AF647 1 :50 Rat BD Biosciences 561145 ++

SSEA4-AF488 1 :100 Mouse STEMCELL 60062AD ++

Technologies

TRA-1 -60R-PE 1 :100 Mouse STEMCELL 60064PE ++

Technologies

PDX1 1 :100 1 :100 Goat R&D Systems AF2419 +++

NKX6.1 1 :50 1 :50 Goat R&D Systems AF5857 +++

Insulin 1 :300 1 :300 Guinea Dako A0564 +++

Pig

FVD-eFluor780 1 :1000 N/A Invitrogen 65-0865-14 +++

[00113] Quantitative RT-PCR and qualitative PCR

[00114] Total RNA was extracted using the mirVana™ imiRNA Isolation Kit

(Invitrogen, Cat# AM1560). cDNA was synthesized from 100 ng total RNA using the High-Capacity cDNA Reverse Transcription Kit (Invitrogen, Carlsbad, CA). cDNA samples were then subjected to PCR amplification with custom-designed primers for NTR and HSV-TK as well as previously described primers. For the NTR gene, the primers were: forward 5'-CCCCACAGGCAGTGCT-3' (SEQ ID NO: 35); reverse 5'- GTTAGTCCCGGGCAGTGTAG-3' (SEQ ID NO: 36); and the FAM probe 5'- TTGTCGCTCTGATCCC-3' (SEQ ID NO: 37). For the HSV-TK gene, the primers were: forward 5'-CCAAAGCAGCCAACGATAAGG-3' (SEQ ID NO: 38; reverse 5'- CCATCCACTCAGCATCGTCATG-3' (SEQ ID NO: 39); and the FAM probe 5'- TCGGCAAAGAATTTC-3' (SEQ ID NO: 40). Qualitative PCR was performed using surveyor primers designed to flank HSV-TK and NTR genes. For HSV-TK, the forward primer was 5'- CCCGGGACTAACATTGTGCT-3 '(SEQ ID NO: 41 ); and the reverse primer 5'-CAGCTCGGGTGCTCTAAACA-3' (SEQ ID NO: 42). For NTR, the forward primer was 5'-CCTCACATGTGGTCGTGTTT-3' (SEQ ID NO: 43), and the reverse primer 5'-ACCTGTTTTGCCATCCACTC-3' (SEQ ID NO: 44). PCR was performed using the NEB interactive protocol design software (New England Biolabs, Ispwich, MA;

available at the website at protocols. io/view/PCR-with-Taq-DNA-Polymerase-M0273- imst9m).

[00115] Mouse transplantation experiments

[00116] All animal experiments were conducted under the supervision of the

University of Miami Institutional Animal Care and Use Committee (IACUC). NOD-SCID mice (5-6 weeks old; Jackson Laboratories, Bar Harbour, ME) were housed in nonspecific pathogen-free (SPF) conditions at the Division of Veterinary Resources (DVR). 5 x 10 ⁶ hESc were resuspended in 50 μΙ mTeSR supplemented with 10mM of the ROCK inhibitor Y-27632A, and subsequently mixed with undiluted Matrigel of equal volume. The cell suspension was injected into the subcutis of the left posterior dorsal flank of the animal. Tumor growth was monitored with a caliper. Mice were euthanized after the observation/re-treatment period, as described in the Results section. Euthanized animals were subject to general observation. The injection site was inspected and tumor tissue, if present, was collected and processed for histopathological analysis. Lungs, liver spleen and pancreas were also harvested for histological analysis of potential tumor invasion.

[00117] Histological analysis, Immunofluorescence Staining and Cellular Imaging

[00118] Cells for Immunofluorescence staining were cultured in 4 well chambered slides (NUNC™ Lab-Tek™ Chamber Slide™ System; Thermo Fisher Scientific, Waltham, MA) coated with Matrigel. Cells were then fixed with 4% paraformaldehyde. Tumors and tissues were also fixed overnight in 4% paraformaldehyde.

Immunofluorescence was performed as previously described in Cechin et al, 2014 (3).

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[00121] All references, including publications, patent applications, and patents, cited herein are hereby incorporated by reference to the same extent as if each reference were individually and specifically indicated to be incorporated by reference and were set forth in its entirety herein.

[00122] The use of the terms "a" and "an" and "the" and similar referents in the context of describing the disclosure (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. The terms "comprising," "having," "including," and "containing" are to be construed as open-ended terms (i.e., meaning "including, but not limited to,") unless otherwise noted.

[00123] Recitation of ranges of values herein are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range and each endpoint, unless otherwise indicated herein, and each separate value and endpoint is incorporated into the specification as if it were individually recited herein.

[00124] All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., "such as") provided herein, is intended merely to better illuminate the disclosure and does not pose a limitation on the scope of the disclosure unless otherwise claimed. No language in the specification should be construed as indicating any non-claimed element as essential to the practice of the disclosure.

[00125] Preferred embodiments of this disclosure are described herein, including the best mode known to the inventors for carrying out the disclosure. Variations of those preferred embodiments may become apparent to those of ordinary skill in the art upon reading the foregoing description. The inventors expect skilled artisans to employ such variations as appropriate, and the inventors intend for the disclosure to be practiced otherwise than as specifically described herein. Accordingly, this disclosure includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above- described elements in all possible variations thereof is encompassed by the disclosure unless otherwise indicated herein or otherwise clearly contradicted by context.